1. Technical Field
The present application relates to endoscopic surgical instruments, and more particularly to endoscopic surgical instruments for aspirating, irrigating and blowing air at a surgical site.
2. Background of Related Art
Surgical devices for providing irrigation fluid and suction force to a surgical site to irrigate and evacuate the tissue in the area on which the surgical procedure is being performed are well known in the art. Several of these devices provide a handle member having a switching mechanism for turning on and off the flow of the fluid stream and suction force, and typically connect the suction source and the fluid source to an elongated flexible tubular member which is positioned adjacent the surgical site. In many instances, the tube or catheter includes a complex series of passages which provide a separate channel for the irrigation fluid and a separate channel for the suction force. Several devices include a pump source to provide the fluid under pressure; however, other devices provide a source of irrigation fluid which is operable under head pressure to gently wash the tissue. The prior art devices typically provide a large tube or catheter which enclose the several channels to deliver the fluid and provide the suction during oral surgery, or invasive surgery which allows for the positioning of the cumbersome tubing.
Several of the prior art devices provide numerous features including electrocautery, laser dissection, and viewing capabilities. Typically, the handle grip includes on/off switches in the form of trumpet valves which allow the surgeon to selectively choose the suction or irrigation feature. Many devices provide a pistol-type hand grip which allows the surgeon to operate the device with the thumb-actuated valves. Other devices provide tubular connections such as Luer-type connectors to couple the irrigation source or the suction source to the catheter or tube. Surgical devices for blowing air at a surgical site to improve visibility are also well known. Typically, these are separate devices.
With the recent developments in endoscopic and laparoscopic surgical procedures, it is necessary to provide a device in which many of the functions provided by the more complex and cumbersome prior art devices are included in a streamlined construction in which many of the features are provided in a single unit. In laparoscopic and endoscopic surgical procedures, a small incision or puncture is made in the patient's body to provide access for a tube or cannula device. The cannula is inserted into the patient's body through the provision of a trocar assembly which further includes an obturator for penetrating the body wall. After the obturator is removed, the cannula remains in place to maintain access to the surgical site. Once the cannula is in place, the surgical instrument may be inserted through the cannula to perform the procedure, while the surgical area is viewed through an endoscope or a miniature camera inserted through secondary cannulas to display the procedure on a video monitor.
The prior art devices are subject to several disadvantages when considered for use in laparoscopic or endoscopic surgical procedures. The primary focus behind such surgical procedures is that the surgery is minimally invasive to the patient's body, consequently reducing damage to surrounding tissue and organs and reducing the scarring resulting from the operation, which, as a result, greatly reduces recovery time for the patient. The prior art devices, which typically provide a plurality of channels in the tube or catheter portion to transport the suction force and irrigation fluid to the surgical site, are generally provided for invasive type surgery which allows the larger diameter catheters to be manually positioned adjacent the surgical objective through large incisions. Also, as discussed above, a separate device is required for blowing air at the surgical site.
Typical suction and irrigation devices having a hand grip in the shape of a pistol are disclosed in U.S. Pat. No. 4,149,315 to Page, Jr. et al. and U.S. Pat. No. 4,776,840 to Freitas et al. Page, Jr. et al. provides a dental suction/irrigation device which includes an elongated tube member which transports the suction force and the irrigation fluid to the tissue site. The elongated tubular member includes a pair of concentric tubes where the inner tube provides the irrigation fluid and the outer tube is provided for the suction. A pair of trumpet valves are provided to actuate the irrigation source and the aspiration source. Freitas et al. discloses a similar device but includes a complex internal manual pump to provide the irrigation fluid. A second flexible tube is provided for a vacuum source to evacuate fluid and gases from the surgical site.
U.S. Pat. No. 4,744,360 Bath provides a surgical device for removing cataract lenses which includes an optical fiber for laser surgery which is surrounded by an irrigation sleeve and a separate aspirator sleeve which provides fluid for irrigation and suction for evacuation, respectively, of the surgical site.
A Cabot Medical Corporation brochure (copyright 1990) discloses a suction/irrigation probe which includes a hydrodissection insert which has a rod which passes through the tube of the suction/irrigation probe to adjust the flow of the irrigation fluid.
U.S. Pat. No. 5,195,958 to Phillips illustrates a suction/irrigation/evacuation device for laparoscopic surgery. The hand piece has a variety of removably mounted attachments.
U.S. Pat. No. 5,310,406 to Sharpe et al. discloses an aspiration device for laparoscopic surgery having a large diameter tube with a proximal end. A tool access port concentric with the tube permits insertion of a grasping tool for holding a sponge at the distal end of the tube.
U.S. Pat. No. 5,312,332 to Bales et al. discloses an endoscopic electrosurgical suction-irrigation instrument which includes a valve through which an endoscopic tool may be inserted. The suction-irrigation instrument also includes a insulating sliding sleeve disposed about the metal cannula.
U.S. Pat. No. 5,322,503 to Desai discloses an endoscopic instrument for suction-irrigation which includes a port for the reception of instrumentation therethrough. The suction-irrigation instrument also includes electrocautery capabilities and a detachable probe which can be provided with a variety of working tips.
Other known devices include U.S. Pat. No. 4,921,476 and U.S. Pat. No. 4,493,694 to Wuchinich, and U.S. Pat. No. 3,527,203 to Gravlee, which include a tube having several channels for carrying the irrigation fluid separately from the suction device.
While these devices provide a way of communicating the fluid source to the surgical site, these prior art instruments typically operate only in a low pressure range, generally up to 25 psi. It has been found that in many surgical procedures, higher pressures are favorable to provide for hydrodissection, i.e. cutting through tissue by high pressure fluids. In addition, it is also necessary at times to provide greater aspiration forces to remove fluid, tissue, etc. A problem associated with the prior art devices is that many incorporate valve systems which are incapable of withstanding the higher static pressures. Furthermore, prior art devices generally provide for only a single irrigation or hydrodissection pressure for application at the surgical site. While it may be necessary to increase or lessen the pressure at the surgical site, many prior art devices do not provide this feature, and in these devices only the use of an external valve mechanism will accommodate such a feature.
In addition, while some prior art devices provide for other features such as electrocautery and laser cutting capabilities, in addition to suction and irrigation, these devices tend to have specific surgical applications, i.e. electrocautery only or laser only uses. In order to vary the procedure, the surgeon must switch instruments, thus requiring a number of instruments to be available in the operating room, e.g., a suction/irrigation device, an air blowing device, and an electrocautery device. The instruments also tend to be bulky, since separate, insulated lumens are often required in the cannula portion to permit electrocautery and laser procedures without injury to the patient or surgeon.
The novel endoscopic surgical device for suction, irrigation and blowing of tissue during a surgical procedure obviates the disadvantages encountered in the prior art and provides a compact instrument which includes many of the features necessary to perform the surgical procedure, and which is dimensioned to fit through a cannula for the performance of endoscopic or laparoscopic surgical procedures. The device also may accommodate higher pressures for the fluid source and the suction source by providing a novel valve mechanism having an improved valve, capable of withstanding static pressures of up to about 75 psi. The device of the present application includes a slidable sleeve to vary the suction forces gas, e.g. air and irrigation pressure as well as protect the tip of the instrument, particularly electrocautery tips. The working tip may be changed during the procedure, if desired, through the provision of interchangeable cannula tubes. In addition, the device described herein may be provided with an instrument insertion port for receiving a surgical instrument to be utilized with the suction and irrigation device during the surgical procedure.